There are distinct classifications of paraphilias, which can be sorted in terms of their application. Any such disorder, to be clincally recognized, must be characterized by a 6-month period of recurrent, intense, sexually arousing fantasies or sexual urges involving a specific act, depending on the paraphilia.Obtain a complete history and perform complete mental status, physical, and neurological examinations to assist with the evaluation and to rule out other disease processes.Rule out major medical or psychiatric illnesses. Look for both hard and soft neurological signs involving the striato-thalamo-cortical processing loop (theory).

The definition and clinical diagnosis demanded by the DSM-IV for a "mainline" paraphilia is rather restrictive. The previous section covered an overview of paraphilia. This section will detail each component.

The DSM-IV recognized seven types of paraphilia as clinical in nature, and threw all the rest into a single code under the heading "Paraphilias not otherwise classified". The reason these seven are clinical is due to several reasons.[1]

The first reason is that it is believed, to a large extent, that all humans have at least limited paraphiliac tendencies in these seven categories. While this may sound somewhat disturbing, the theory goes that these things are seen as deviant due to the fact that normal people can control these minor urges. In everyday life, people have minor urges towards voyeurism, masochism, exhibitionism, and certainly frotteurism. Many people have sadistic or pedophiliac arousal and feel disgusted over such. These things are suppressed in almost all people, as multiple tests have shown.[2]

The second reason these are "clinical" paraphilias is that they occur in a large enough segment of the population to have been tested and examined under clinical conditions. Literally any action or interaction could be the basis for a paraphilia, including such outlandish thing as ghosts, food, or even tinsel. (These, amusingly, have all been reported)[3] The seven clinical types have clear definitions for diagnosis and clear-cut legal, culture, and moral issues of concern to both psychiatrists and the public at large.

Dr. John Wincze, a abnormal psychology researcher and expert on paraphilia, wrote a long paper on why the clinical paraphilia's were so important, and why so little attention was paid to other paraphilia types:

The primary consideration in determining the clinical significance of a paraphilial sexual disorder is proportional to the effects such disorders have on society as a whole. The more inherently dangerous paraphilia, such as lust murder syndrome and rape fixation, are so intertwined with the crimes necessary that studying them is a matter for criminal rather than sexual psychology. On the other hand, the actions of the unclassified paraphilias are, in light of their actual focus, quite harmless. One rarely hears about someone who enjoys the feel of silk becoming an issue of law. However, the clinical paraphilias are both widely spread and disturbing in nature. Many of them involve or could involve involuntary participation. All of them involve, with the lamentable and archaic exception of tranvestic fetishism, issues of criminality and mental stability.[4]

Voyeurism is an uncontrollable attraction to, and arousal from, the act of observing unsuspecting individuals, usually strangers, who may be naked or in the process of disrobing, engaging in sexual activity, or otherwise naked. The voyeur is different than a person who simply enjoys nakedness or watching people have sex, since the arousal comes from the fact the other person is unaware they are being watched. Related behaviors often include various antisocial disorders.

The DSM-IV lists the main criteria for the diagnosis as being:

Having intense sexual desires, fantasies or behaviors concerning the act of watching an unsuspecting person who is naked, disrobing or having sex for a long period of time.

Voyeuristic activity is the primary mode of sexual arousal and expression. The subject is increasingly incapable of sexuality without this activity.

Voyeuristic activity causes clinically important distress or impairs work, social or personal functioning.

Onset is typically before the age of fifteen, and in 60% of cases studied, the individual may become so invested in the voyeuristic activity as to have this as the sole sexual behavior. This often is a chronic condition.

Levels:

Standard : A standard voyeur will regularly engage in acts of voyeurism, and will attempt to incorporate voyeuristic themes into any sexual acts with others (watching their sexual partner engage in sex with a third person, for example).

Preferred : A preferred voyeur will have increasing difficulty in maintaining personal sexual relationships, instead trying to find ways to view unaware persons in the act of disrobing or having sex.

Focused : A focused voyeur will be unable to resist their tendencies. They will almost never actually have direct sexual contact with other persons, and will usually purchase equipment to enhance their voyeuristic tendencies. Some may go so far as to commit breaking and entering to observe directly.

Many people have some voyeuristic tendencies, usually below the clinical threshold. The primary clinical factor is the requirement that the subject be unaware. A voyeur would not, for example, be interested in going to a strip club.

This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors involving sexual activity with a pre-adolescent child , usually 13 or younger. To be considered for this diagnosis according to DSM-IV, the person must be at least 16 years old and at least 5 years older than the child.

Levels:

Standard : A standard paedophiliac will almost certainly not engage in actual intercourse with children. They will almost certainly use paedophilaic imagery, and may commit acts of voyerism against children. Some will use ageplay, or seek to have sex with young-looking adults.

Preferred : A preferred paedophliac will try to commit at least peripheral contact with children in a sexual manner. They will certainly use paedophilaic imagery. Some, if they have children, will seek to molest them.

Focused : A focused paedophiliac will be unable to resist attempting to prey on children, and may resort to criminal acts to meet his needs. If they have children, they will almost certainly be molested repeatedly.